Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis

Jia, Baixue; Feng, Lei; Liebeskind, David S; Huo, Xiaochuan; Gao, Feng; Ma, Ning; Mo, Dapeng; Liao, Xiaoling; Wang, Chunjuan; Wang, Wenjuan; Pan, Yuesong; Li, Hao; Liu, Liping; Wang, Yilong; Miao, Zhongrong

doi:10.1136/neurintsurg-2017-013489

Cited by 128 publications

(105 citation statements)

References 22 publications

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“…Other factors may include underlying vessel disease such as atherosclerosis, dissection, or vasculitis. 10,11 According to current observational studies, thrombus length has not been shown to effect retrieval efficacy. 28,29 Besides clot and occlusion site characteristics, stent-retriever dwelling time 30 and respective deviceclot interaction, 8 may serve as additional contributing factors.…”

Section: Retrieval Failuresmentioning

confidence: 97%

“…Reasons for such reperfusion failures may range from difficulty establishing cervical or intracranial access to the inability to dislocate and retrieve the clot despite having reached the target location and having established intracranial access. 8,9 Further conceivable explanations for failures to reestablish flow are underlying nonembolic vessel diseases (eg, vasculitis, intracranial atherosclerosis) 10,11 or thrombi of nonthrombotic origin and extraordinary composition, such as calcified or neoplastic thrombi. 12,13 The aim of this analysis was to provide estimates of the relative frequencies of underlying causes of reperfusion failure in patients with acute ischemic stroke who underwent angiography with an intention to perform stent-retriever-based thrombectomy.…”

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confidence: 99%

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Reasons for Reperfusion Failures in Stent-Retriever-Based Thrombectomy: Registry Analysis and Proposal of a Classification System

Kaesmacher

Gralla²,

Mosimann³

et al. 2018

AJNR Am J Neuroradiol

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Section: Retrieval Failuresmentioning

confidence: 97%

mentioning

confidence: 99%

Reasons for Reperfusion Failures in Stent-Retriever-Based Thrombectomy: Registry Analysis and Proposal of a Classification System

Kaesmacher

Gralla²,

Mosimann³

et al. 2018

AJNR Am J Neuroradiol

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“…With regard to our findings, we speculate that intracranial stenting on recently symptomatic, still vulnerable plaques are more likely to cause plaque dislodgement, perforator stroke, and intracranial hemorrhage. Fourth, a previous study found good collaterals were developed in the later stenting group which sustained the blood supply of the occlusion artery and reduced the risk of ischemic events 20…”

Section: Discussionmentioning

confidence: 94%

Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke

Zhang

Sun

et al. 2019

J NeuroIntervent Surg

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ObjectiveTo evaluate the clinical outcomes of early stenting (≤14 days) or late stenting (>14 days) in patients who underwent intracranial stent placement.MethodsPatients with ischemic stroke caused by 70–99% intracranial atherosclerotic stenosis combined with poor collaterals were enrolled. The early stenting group, who underwent stenting within 14 days of last ischemic symptoms, were compared with the late stenting group who underwent stenting >14 days from last ischemic symptom. The patients were treated either with a balloon-mounted stent or a self-expanding stent as determined by the operators following a guideline. The baseline characteristics and clinical outcomes were evaluated and compared.ResultsOne hundred and fifteen stroke patients were recruited into the study. Four patients (4/41) in the early stenting group and two patients (2/74) in the late stenting group were diagnosed with a cerebral vascular event associated with stenting within 3 days (p=0.184). In the long-term follow-up, eight patients in the early stenting group had restenosis ≥50%, which was higher than patients in the late stenting group (8/41 vs 4/74, p=0.018). The total rates of any ischemic stroke, transient ischemic attack, hemorrhagic stroke, and death in the early stenting group were higher than in the late stenting group (9/41 vs 6/74, p=0.035). The recurrence rate of ischemic stroke in the early stenting group was higher than in the late stenting group (5/41 vs 2/74, p=0.041).ConclusionsStent placement in the setting of ischemic stroke caused by intracranial artery stenosis within 14 days may confer a higher risk of long-time cerebral vascular events and lead to a higher risk of restenosis.Clinical trial registrationNCT01968122.

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“…Accordingly, the best currently available evidence for the endovascular treatment of ICAD is based on the SAMMPRIS and the VISSIT study (4,5) showing the superiority of best medical treatment over elective intracranial stenting. Recently, acute intracranial stenting (ICS) has been reported to be a highly promising bailout strategy for theses frustrating thrombectomy cases with predictably poor outcomes (6)(7)(8)(9)(10)(11). Since these cases are still rare, past retrospective studies mostly analyzed heterogeneous cohorts, including a wide range of stroke severities (12).…”

Section: Introductionmentioning

confidence: 99%

Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study

et al. 2020

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Results: Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1-4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5-8) on admission to 2.5 (IQR 0-8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41). Conclusion: ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

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Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis

Abstract: NCT02350283 (Post-results).

Cited by 128 publications

References 22 publications

Reasons for Reperfusion Failures in Stent-Retriever-Based Thrombectomy: Registry Analysis and Proposal of a Classification System

Reasons for Reperfusion Failures in Stent-Retriever-Based Thrombectomy: Registry Analysis and Proposal of a Classification System

Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke

Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study

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